Can A Migraine Cause A Fever?

Migraines fall under the primary category of headaches, which are headaches not triggered by another medical condition. Other types of headaches in this category include cluster headaches and tension headaches.

Headaches are a common occurrence that affects anyone regardless of age, gender, or race and can be treated using over-the-counter medications like aspirin, ibuprofen, and acetaminophen. However, a headache accompanied by a fever requires medical attention right away. It may be a sign of a serious infection.

A migraine accompanied by fever has several causes, including meningitis, encephalitis, brain abscess, and sinus infection. We shall look into the above-mentioned possible causes, including the symptoms, diagnosis, and treatment.

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Meningitis

Meningitis is a serious infection of the membranes surrounding the spinal cord and brain. It is caused by a virus, bacteria, or fungus.

Viral meningitis is less dangerous and mostly affects children. It is caused by viruses, such as herpes simplex virus, HIV, mumps virus, and West Nile virus. They are transmitted through fluids in the mouth, nose, and feces.

Bacterial meningitis is much more severe and caused by bacteria in the nose and throat. The bacteria include streptococcus pneumonia and group B streptococcus, among others. These bacteria are not harmful, but once they enter the bloodstream, they spread to the membranes surrounding the brain and infect it.

Bacterial meningitis is classified as a medical emergency. Fast diagnosis and treatment are needed because they can kill in hours.

Fungal meningitis is rare and not contagious like viral and bacterial meningitis. Still, the symptoms are the same.

Symptoms

The following are the common symptoms of meningitis:

  • High fever with migraine

  • Pain and stiffness in the neck

  • Sensitivity to light

  • Red-purple skin rash

  • Nausea and appetite loss

  • Muscle and joint pains

  • Irritability and confusion

  • Seizures

The viruses and bacteria that cause meningitis are spread through body fluids shared through kissing, sneezing, coughing, and sharing personal items.

Diagnosis

A blood test is conducted, or a needle is inserted into the lower back to extract fluid around the base of the spinal cord. The fluid is examined for infection.

Treatment

Treatment depends on the type of infection. Meningitis patients can be admitted to the hospital or cared for at home under close medical supervision.

Bacterial meningitis treatment

Injectable or intravenous antibiotics are used for up to three weeks. Corticosteroid medicines may be given to deal with the possibility of seizures or brain swelling.

Viral meningitis treatment

Acetaminophen can alleviate migraine and fever,  and patients are advised to get plenty of rest and fluids. Antibiotics are not used in the case of viral meningitis because they are not effective against it.

Fungal meningitis treatment

High-dose and long-course antifungal medicines are administered intravenously. 

Reducing the risk of catching meningitis

Good hygiene is key. You can prevent contracting meningitis by following these guidelines:

  • Sneeze into your elbow or a handkerchief.

  • Avoid sharing cups and personal items.

  • Discard tissues into a bin after using them.

  • Wash your hands regularly with soap.

Note: Some of these bacteria and viruses that cause meningitis are preventable through childhood immunization.

Encephalitis

Encephalitis is the inflammation of the brain's active tissues caused by an infection. The brain swells, causing symptoms such as migraine, confusion, and seizures.

Encephalitis falls under two categories, infectious and autoimmune.

Infectious encephalitis

A virus causes infectious encephalitis. Nowadays, measles, rubella, mumps, and chickenpox vaccines have lowered the rate of encephalitis. 

However, other viruses such as herpes simplex virus type 1 and 2 and the varicella-zoster virus can cause encephalitis.

Animals and insects like ticks and mosquitoes also carry infectious encephalitis viruses like Chikungunya and the West Nile virus. Infectious encephalitis can be caused by bacteria, fungi, and parasites in rare cases.

Autoimmune encephalitis

Autoimmune encephalitis happens when the body's antibodies attack the brain. The type of autoimmune encephalitis will depend on the specific proteins or receptors targeted by the antibodies.

Here are two types of autoimmune encephalitis and the type of receptor cells attacked:

  • Anti-NMDA (N-methyl-D-aspartate) receptor encephalitis: The immune system attacks the NMDA receptors in the brain.

  • VGKC (Voltage-gated Potassium channel)-complex antibody encephalitis: The immune system targets the VGKC protein complex.

Sometimes, autoimmune encephalitis can result from a benign or cancerous tumor.

An infection causes other types, such as acute disseminated encephalomyelitis (ADEM).

Symptoms

Symptoms differ according to the affected brain area and the associated antibody.

Infectious encephalitis begins with migraine and flu-like symptoms. It may then evolve into an altered state of mind that distorts thinking, reasoning, and remembering.

Physical symptoms

The following are the initial symptoms of encephalitis:

  • Fever and migraine

  • Seizures

  • Light and sound sensitivity

  • Loss of consciousness

  • Stiff neck

  • Disorderly movement

When the symptoms start becoming severe, the following might follow:

  • Partial arm and leg paralysis

  • Speech and hearing impairment

  • Coma

  • Double vision

Cognitive symptoms

Encephalitis may also include cognitive symptoms, including the following:

  • Hallucinations

  • Loss of memory

  • Disorientation

  • Anxiety

  • psychosis

Diagnosis

Your healthcare provider may ask about your medical history with you and perform a medical exam. They may inquire whether you have had a recent insect bite or have traveled. Then they may perform these tests:

  • Blood, urine, and stool tests that reveal organisms or antibodies causing infection

  • Electroencephalogram (EEG) to identify any brain activity that may trigger seizures

  • Drawing fluids from the base of the spine to check for brain or spinal infection

  • Neuroimaging using computerized tomography (CT)  scans or magnetic resonance imaging (MRI)

  • Measuring skull pressure to identify swelling

  • Sputum tests to check for lung infections

In rare cases, your doctor may request to perform a biopsy of the affected brain tissue.

Treatment

Some patients may be requested to stay at the hospital so that they may be monitored for brain swelling, seizures, or respiratory complications.

Common encephalitis treatments include:

  • Antibiotics to fight bacterial infections

  • Antiviral medication to fight virus infection in the brain

  • Seizure control therapy or medication

  • Steroids or plasma exchange for immunotherapy

  • Urinary catheter and breathing or feeding tube

  • A ketogenic diet for patients unresponsive to seizure medication

Measures to prevent encephalitis

Preventing encephalitis may be possible through the following measures:

  • Wash your hands regularly to kill bacteria and viruses

  • Protect yourself from ticks and mosquito bites

  • Keep vaccinations up to date when traveling

Brain Abscess

A brain abscess occurs when bacteria or fungi enter the brain tissue, usually after an infection or head injury. The abscess is usually pus-filled and swollen.

Symptoms

Brain abscess symptoms may develop quickly or slowly. They resemble those of meningitis  or encephalitis and include:

  • Severe headache accompanied by a high temperature

  • Nerve function problems like muscle weakness or slurred speech

  • Distorted mental states, such as irritability or confusion

  • Blurred vision, graying vision, or double vision

Causes

A brain abscess can develop in three main ways:

  • Infections in the skull such as an ear infection, dental abscess, or sinusitis that may spread into the brain

  • Infection through the blood where a person with a weak immune system is at a higher risk

  • Direct trauma to the head, such as through injury, where the skull opens, allowing bacteria or fungi to access the brain

Diagnosis

The first assessment is usually made based on your medical history, symptoms, and any case of infection or weakened immune system. You may also have a CT scan or an MRI scan.

If an abscess is located, a testing sample is obtained by inserting a needle and using a CT scan to guide it to the abscess.

Treatment

Treating a brain abscess involves combining surgery and medicine according to the number of brain abscesses.

Medicine is usually administered before making a diagnosis to minimize the risk of complications.

Medication

Sometimes, an abscess can be treated with medicine only, or the medicine may be administered because surgery may be risky for the patient.

Medicine is preferred over surgery if:

  • An abscess is less than 2cm

  • An abscess is inside the brain

  • There are several abscesses

  • Meningitis is present

  • There is hydrocephalus

The antibiotics and antifungal medicine for treatment are given through a drip.

Surgery

Surgery is recommended if the abscess is larger than 2cm. There are two surgical methods to treat a brain abscess:

  • Simple aspiration: A CT scan is used to locate the abscess, and a small hole is drilled. The pus is then drained and the opening sealed. This procedure takes about an hour.

  • Craniotomy: If the abscess is not responsive to aspiration or it reoccurs, a piece of the skull is removed to gain access and remove the abscess. It takes about three hours.

Sinus infection

A sinus infection or sinusitis is inflammation of the air spaces around the nose and eyes. The sinus drainage becomes blocked, causing pressure and pain.

Acute sinus infections

Acute or subacute sinus infections begin with inflammation of the nasal passages caused by an irritant, an infection like the common cold, or an allergy. The inflammation causes blocking, which results in infection.

Chronic sinus infections

Chronic or recurrent sinus infections happen due to ongoing inflammation. It develops due to fungal allergies, cigarette smoke, or repetitive viral infections.

Structural abnormalities in the sinuses, such as enlarged adenoids or turbinates, may prevent the sinuses from draining.

Fungal sinus infections

Fungal sinus infections occur as invasive or non-invasive fungal balls. These fungal balls are formed when dead cells from inflammation build up in the sinus.

Fungal sinus infections are not common. They occur when a person's immune system is very weak.

Symptoms

Sinusitis symptoms are categorized based on how long the infection has lasted. Acute symptoms last for less than four weeks, while subacute symptoms between four and 12 weeks. Chronic symptoms last 12 or more months. 

Here are the symptoms associated with sinus infections:

  • Fever and migraine

  • Decrease in smell and taste

  • Bad breath and taste

  • Colored nasal discharge

  • Nasal congestion

  • Ear pressure or pain

Diagnosis

Your healthcare provider will diagnose sinus infection by conducting a physical examination and relying on the symptoms you exhibit. They may use a small flexible tube called an endoscope to look into your sinuses. A mucus sample can also be taken to determine if there is a bacterial or fungal infection. 

Uncomplicated acute or subacute sinus infection does not require additional tests.

However, you may be tested for allergies if they are suspected as the cause. Recurrent or chronic sinusitis may require you to undergo a CT imaging to find the cause.

Treatment of sinus infection

Acute or subacute viral sinus infections resolve themselves within a few days. The only thing needed for your comfort is a saline nasal spray to remove mucus from the nasal passages and pain relievers like acetaminophen to ease the headache.

In case of severe inflammation, oral steroids are recommended. Other medications may include oral or topical decongestants and antibiotics, depending on whether there is a bacterial infection.

Surgery is required in cases where structural problems like nasal polyps cause recurrent sinus infections.

You can reduce the risk of catching a sinus infection by following these guidelines:

  • Wash your hands regularly with soap or use sanitizer.

  • Avoid contact with tobacco smoke and other allergens.

  • Use a humidifier to get rid of dry air in your home.

The lowdown

Whenever your body is under attack from illness, fever is how your body responds to the attack.

Having a migraine may mean the fever contributes to it, or the infection could also contribute to the headache.

Severe headaches accompanied by fever may signal a serious condition such as meningitis, encephalitis, or brain abscess. It could also indicate a sinus infection, cold, flu, heatstroke, rheumatoid arthritis, HIV or AIDS, or lupus.

Common headaches that are not severe or are not accompanied by fever occur to most people and are no cause for alarm. But if they are accompanied by a fever and other symptoms like sensitivity to light or neck stiffness, see your doctor for proper diagnosis.

Other sources:

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